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Shneyderman M, Shen S, Tanavde V, Kut C, Kiess AP, Naunheim MR, Akst LM. Factors Impacting Provider Treatment Decision-Making in Early Glottic Cancer. Laryngoscope 2024; 134:3686-3694. [PMID: 38727258 DOI: 10.1002/lary.31494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Transoral laser microsurgery (TLMS) and radiotherapy (XRT) are mainstays of treatment for early glottic carcinoma (EGC). Here, we investigated case-dependent provider treatment preferences and identify factors which impact decision-making in EGC. METHODS This cross-sectional survey of laryngologists, head-and-neck surgeons, and radiation oncologists presented five diagrammatic cases of progressively advanced EGC (T1/2, N0). Respondents indicated preference for TLMS or XRT and ranked factors which influenced their recommendation for each case. Analysis utilized descriptive statistics, Fischer's exact tests, and Kruskal-Wallis tests for nonparametric data. RESULTS A total of 141 complete responses (69.5% laryngologists) were received. Most respondents practiced in academic settings (93.5%) and within multidisciplinary teams (94.0%). Anterior commissure involvement was the most important a priori tumor factor for case-independent treatment recommendation (Likert Scale: 4.22/5), followed by Laterality (Likert Scale: 4.02/5). Across all specialties, TLMS was recommended for unilateral T1a lesions. Laryngologists continued recommending TLMS in T2 lesions (41.0%) more than head-and-neck surgeons (5.0%) and radiation oncologists (0.0%). Across all cases, survival and voice outcomes were the most important clinical factors impacting treatment decisions. Radiation oncologists weighed voice more heavily than laryngologists in more complex presentations of EGC (rank: 1.6 vs. 2.7, Kruskall-Wallis: p < 0.05). CONCLUSIONS In more complex clinical presentations of EGC, preference for TLMS compared to XRT differed across specialists, despite similar rankings of factors driving these treatment recommendations. This may be driven by differing experiences and viewpoints on case-dependent voice outcomes following TLMS versus XRT, suggesting a need for increased understanding of how tumor location and depth impact voice outcomes. LEVEL OF EVIDENCE 5 Laryngoscope, 134:3686-3694, 2024.
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Affiliation(s)
- Matthew Shneyderman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarek Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ved Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carmen Kut
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Matthew R Naunheim
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Rosow DE, Keidar E, Pasick LJ, Casellas NJ, Anis MM. Use of the 445-nm Blue Laser for Management of Early Glottic Carcinoma: Preliminary 1-Year Results. Laryngoscope 2024. [PMID: 38860434 DOI: 10.1002/lary.31569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To analyze oncological efficacy and voice outcomes of the 445-nm blue laser (BL) in the treatment of early glottic carcinoma and compare results with the 532-nm potassium-titanyl-phosphate (KTP) laser. STUDY DESIGN Single institution, retrospective chart review. METHODS All patients who underwent microlaryngoscopic KTP or BL laser excision of early glottic carcinoma from 2018 to the present day with at least 1-year follow-up were included. Primary and recurrent disease, including radiation and surgical failures, were included. Demographic data, voice outcomes and oncologic outcomes were compared between the two laser groups. RESULTS Forty-nine patients met the inclusion criteria for the BL group and 88 for the KTP group, with average follow-up of 635 and 1236 days, respectively. Oncologic outcomes were not significantly different, with disease-specific survival rates of 95.9% for BL and 100% for KTP (p = 0.13), organ preservation rates of 98.0% for BL and 95.6% for KTP (p = 0.39), and local control rates of 93.9% for BL and 92.1% for KTP (p = 0.81). Both BL and KTP groups showed significant improvement in CAPE-V (p = 0.04, 0.006 respectively) and VHI-10 scores (p = 0.003, <0.00001) following surgery. CONCLUSIONS Photoangiolytic removal of early glottic carcinoma with BL appears to be equally safe and effective as with KTP laser at minimum one-year follow-up, and with excellent voice outcomes. Additional study will be warranted over time to assess long-term outcomes in BL patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- David E Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eytan Keidar
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luke J Pasick
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas J Casellas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mursalin M Anis
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Ben Ner D, Hamzany Y, Reuven Y, Ben-Mordechai N, Bar-On DY, Najman TM, Shoffel-Havakuk H. Too Deep: The Rate of Inappropriate Deep Resections while Practicing a Single Stage Laser Cordectomy. J Voice 2024:S0892-1997(24)00155-3. [PMID: 38811305 DOI: 10.1016/j.jvoice.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Whenever a cortectomy is indicated, obviating preoperative biopsy and practicing a single-stage-laser-cordectomy (SSLC) may expedite treatment and preserve surgical planes. This may result in more superficial resections and improved vocal function. Yet, SSLC holds a risk for over-treating nonmalignant lesions. Our study aims to evaluate this risk. METHODS A retrospective cohort of patients who underwent SSLC. Cordectomy types were compared with final pathology. Type-1 cordectomy was subcategorized into superficial-type-1 (superficial-lamina-propria preserved) and deep-type-1 (ligament exposed). Superficial-type-1 cordectomy was considered adequate for epithelial lesions not invading the basement membrane: nonmalignant, dysplasia, and carcinoma-in-situ (CIS). Deeper resections for these pathologies were considered inappropriately deep. All resections were considered appropriate for squamous cell carcinoma (SCC). RESULTS Ninety-seven patients who underwent 139 SSLC were included. SCC was found in 30% (N = 42), CIS/severe-dysplasia in 15% (N = 21), mild/moderate-dysplasia in 23% (N = 32), nondysplastic lesions in 31% (N = 43), and lymphoma in 0.5% (N = 1). Superficial-type-1 cordectomy was performed in 64% (N = 89). Altogether, 15 lesions (11%) underwent inappropriately deep resections. Smoking history, current smoking status, prior glottic surgery, radiation or fungal infection, did not increase the rate of inappropriate deep resection. While the general rate of inappropriately deep resection is 11%, for deep-type-1 cordectomy or deeper the rate was 29.4%. The highest rate was associated with deep-type-1 cordectomy, reaching 52.9%. CONCLUSION The general rate of inappropriately deep resection during a SSLC is low. However, when the depth of resection involves exposure of the vocal ligament or deeper, the rate increases. Hence, to avoid unnecessary morbidity, whenever a deep resection is considered, the authors recommend preceding a deeper resection with frozen section sampling.
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Affiliation(s)
- Daniel Ben Ner
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Hamzany
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Ben-Mordechai
- Department of Otolaryngology Head and Neck Surgery, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Dvir Yohai Bar-On
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzvi Menachem Najman
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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El-Shabrawi K, Burkhardt V, Becker C. Impact of a Multidisciplinary Head and Neck Tumor Board on Treatment and Survival in Laryngeal Carcinoma. Curr Oncol 2023; 30:10085-10099. [PMID: 38132367 PMCID: PMC10742396 DOI: 10.3390/curroncol30120733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Pretherapeutic discussion in the head and neck tumor board (HNT) has been mandatory at the University Medical Center Freiburg since 01/2015, and it is intended to contribute to a survival benefit through interdisciplinary decision making. Prior to 2015, an optional HNT existed in which mainly advanced tumor stages were discussed. The aim of this study was to determine the effect of a pretherapeutic HNT on treatment and survival in laryngeal cancer. METHODS A retrospective data analysis of 412 laryngeal carcinoma patients treated at the Head and Neck Cancer Center of the University Medical Center Freiburg between 01/2010 and 12/2020 was conducted. Differences regarding TNM status, UICC classification, tumor localization, gender and age at initial diagnosis, recurrence, secondary tumors, therapy, 5-year survival, and 5-year recurrence-free survival (5YSR/5Y-RFS) were assessed for therapy initiation with or without a pretherapeutic HNT. RESULTS In total, 314 patients underwent a pretherapeutic HNT, and 98 received therapy initiation without an HNT. The HNT group showed significantly more advanced T stages and UICC classifications (p < 0.001; p = 0.003) and more frequent primary chemo/radiotherapy (p < 0.001). There was no significant difference regarding 5YSR (43 vs. 47 months, p = 0.96) or 5Y-RFS (48 vs. 52 months, p = 0.16). The time between initial diagnosis and therapy initiation was significantly longer when an HNT was performed (38 vs. 20 days, p = 0.008). CONCLUSIONS The HNT group showed significantly more advanced tumor stages, suggesting that even before it became mandatory, it was frequently used for interdisciplinary case discussion in more complex cases. Due to the small number of T3/4 patients in the non-HNT group, a survival advantage of an HNT cannot be validly demonstrated in our study. However, the HNT led to broader patient counselling regarding their therapy options. At the same time, a significant delay in therapy initiation could be seen, suggesting that workflows between diagnosis, HNT presentation, and therapy initiation should be optimized.
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Affiliation(s)
- Katharina El-Shabrawi
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
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Viani GA, Moraes FY, Marta GN, Kowalski LP, Gouveia AG. Real-world evidence for oncological outcomes after radiotherapy or surgery for T1a-T1b glottic squamous cell carcinoma: A population-based cohort study. Head Neck 2023; 45:2505-2514. [PMID: 37555376 DOI: 10.1002/hed.27470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Compare outcomes after surgery (S) or radiotherapy (RT) for T1a-T1b glottic squamous cell carcinoma (T1GSCC) in a population-based cohort study. METHODS Patients diagnosed with T1GSCC from 1999 to 2020 were identified from a public database. Clinical, demographic, and social data were extracted. Treatment and patient groups and subgroups were compared with log-rank test, Cox proportional test, and propensity-score matched (PSM). RESULTS Eight hundred and eighty-eight patients with T1GSCC were included in the study, with a median follow-up of 61 months. The 5- and 10-year overall survival (OS) S versus RT were 76% versus 71% and 60% versus 52% (p = 0.02), respectively. In the subgroup analysis, S was associated with better OS for T1b, male, and public service patients (p < 0.05). In the PSM cohort of S versus RT with 110 patients each, there was no significant difference in the OS, CSS, and LC. CONCLUSIONS T1GSCC has favorable outcomes with S or RT.
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Affiliation(s)
- Gustavo Arruda Viani
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil
- Department of Head and Neck Surgery, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Andre Guimaraes Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
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Uysal B, Gamsiz H, Colak O, Beyzadeoglu M. Outcomes of hypofractionation for early-stage glottic carcinoma. J Cancer Res Ther 2023; 19:1962-1966. [PMID: 38376304 DOI: 10.4103/jcrt.jcrt_378_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/20/2022] [Indexed: 02/21/2024]
Abstract
BACKGROUND Our goal is to evaluate hypofractionation in early-stage glottic carcinoma of a single center in line with randomized trials. MATERIALS AND METHODS Between June 2016 and January 2021, 33 early glottic carcinoma patients treated with IMRT (intensity-modulated radiotherapy) in the Radiation Oncology Department were analyzed. Descriptive statistics and survival analysis were applied. Survival analysis and curves were done via the Kaplan-Meier method. Survival curves were analyzed due to the T stage. Log-rank test was used for the analysis of T stage survival curves. RESULTS Twenty (60.1%) patients were T1 whereas six (18.2%) and seven (21.2%) were Tis. 56.25 Gy, 63 Gy, and 65.25 Gy were delivered to the patients with Tis, T1, and T2, respectively. All groups were treated with 2.25 Gy per fraction. T2 stage had lesser DFS (disease-free survival) compared to Tis and T1 stage and it was statistically significant (P = 0.035). CONCLUSION Hypofractionation with 2.25 Gy per fraction may be standard for early glottic carcinoma with similar results compared to microsurgery and conventional fractionation radiotherapy.
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Affiliation(s)
- Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara, Turkey
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Shelan M, Anschuetz L, Schubert A, Bojaxhiu B, Aebersold DM, Elicin O, Giger R. Superior loco-regional control after primary surgery compared to chemo-radiotherapy for advanced stage laryngeal cancer. Front Oncol 2023; 13:1132486. [PMID: 37593093 PMCID: PMC10431594 DOI: 10.3389/fonc.2023.1132486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/05/2023] [Indexed: 08/19/2023] Open
Abstract
Objective The optimal strategy to treat loco-regionally advanced squamous cell carcinoma of the larynx (LSCC) remains to be defined. The goal of this single institution retrospective study was to report on oncologic outcome of advanced LSCC treated with curative intent. Methods Patients diagnosed and treated for stage T3-T4a LSCC between 2001 and 2014 were retrospectively analyzed. Time-to-event endpoints were calculated beginning from the date of histologic diagnosis, which were analyzed with log-rank test and Cox proportional hazard models. Results The cohort was divided into two subgroups: primary radiotherapy with concomitant cisplatin (CRT) (n=30, 38%) and primary surgery (n=48, 62%). Median follow-up was 56 months. Locoregional control (LRC) for the primary surgery and CRT were 95% and 50% in 5 years, respectively (p<0.01). Progression free survival (PFS) for the primary surgery and CRT were 61% and 38% in 5 years, respectively (p=0.23). The overall survival (OS) after primary surgery and CRT in 5 years were 63% vs. 65%, respectively (p=0.93). The 5-years LRC was significantly superior after surgery compared to RT for cT3 primaries (100% vs 50%, p= 0.0022). No significant differences were observed in the remaining subgroups regarding cT stage and PFS or OS. Conclusion Our series demonstrated superior LRC after primary surgery followed by risk-adapted adjuvant (C)RT compared to primary CRT in cT3 LSCC, but no significant difference in PFS or OS in locally-advanced LSCC. The optimal patient selection criteria for the ideal treatment for loco-regionally advanced LSCC still needs to be defined.
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Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Schubert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos‐Silva AR, Curado MP. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022. Cancer Rep (Hoboken) 2023; 6:e1837. [PMID: 37288471 PMCID: PMC10432469 DOI: 10.1002/cnr2.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
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Affiliation(s)
| | | | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Matheus Ferraz Borges
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
- Head and Neck Surgery Department, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paul Brennan
- International Agency for Research on CancerGenomic Epidemiology BranchLyonFrance
| | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
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Kienle LL, Schild LR, Böhm F, Grässlin R, Greve J, Hoffmann TK, Schuler PJ. A novel 3D-printed laryngoscope with integrated working channels for laryngeal surgery. Front Surg 2023; 10:906151. [PMID: 36998594 PMCID: PMC10043209 DOI: 10.3389/fsurg.2023.906151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundFor the surgical treatment of early-stage laryngeal cancer, the use of transoral laser microsurgery (TLM) has emerged as the gold standard. However, this procedure requires a straight line of sight to the operating field. Therefore, the patient's neck needs to be brought into a hyperextended position. In a considerable number of patients, this is not possible due to anomalies in the cervical spine anatomy or soft tissue scarring, e.g., after radiation. In these cases, adequate visualization of relevant laryngeal structures cannot be ensured using a conventional rigid operating laryngoscope, which may negatively affect the outcome of these patients.MethodsWe present a system based on a 3D-printed prototype of a curved laryngoscope with three integrated working channels (sMAC). The curved profile of the sMAC-laryngoscope is specifically adapted to the nonlinear anatomy of the upper airway structures. The central working channel provides access for flexible video endoscope imaging of the operating field while the two remaining channels provide access for flexible instrumentation. In a user study (n = 11), visualization and reachability of relevant laryngeal landmarks as well as the feasibility of basic surgical procedures with the proposed system were examined in a patient simulator. In a second setup, the system was evaluated for its applicability in a human body donor.ResultsAll participants of the user study were able to visualize, reach and manipulate the relevant laryngeal landmarks. Reaching those took significantly less time in the second attempt compared to the first one (27.5 s ± 5.2 s vs. 39.7 s ± 16.5 s, p = 0.008) indicating a significant learning curve for handling the system. Instrument changes were performed quickly and reliably by all participants (10.9 s ± 1.7 s). All participants were able to bring the bimanual instruments into position for a vocal fold incision. Relevant laryngeal landmarks could be visualized and reached in the human body donor setup.ConclusionPossibly, the proposed system may develop into an alternative treatment option for patients with early-stage laryngeal cancer and restricted mobility of the cervical spine in the future. Further improvements of the system could include finer end effectors and a flexible instrument with a laser cutting tool.
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Affiliation(s)
- Linus L. Kienle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R. Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Rene Grässlin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
- Correspondence: Patrick J. Schuler
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10
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Blomkvist R, Marklund L, Hammarstedt‐Nordenvall L, Gottlieb‐Vedi E, Mäkitie A, Palmgren B. Treatment and outcome among patients with laryngeal squamous cell carcinoma in
S
tockholm—A population‐based study. Laryngoscope Investig Otolaryngol 2023; 8:441-449. [PMID: 37090883 PMCID: PMC10116984 DOI: 10.1002/lio2.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023] Open
Abstract
Objective Survival of patients with advanced laryngeal squamous cell carcinoma (LSCC) remains poor and management protocols warrant further development. We thus investigated treatment and outcome-related factors for LSCC in Stockholm, Sweden. Methods In a retrospective setting, 520 patients with LSCC diagnosed during 2000-2014, were included. Data on stage, treatment, and outcome were correlated with recurrence-free and overall survival (RFS and OS, respectively). Results Five-year OS for all patients was 65%. Five-year RFS for T1a, T1b, T2, T3, and T4 glottic LSCC was 90%, 91%, 77%, 47%, and 80%, respectively. The corresponding figures for T1, T2, T3, and T4 supraglottic LSCC were 64%, 66%, 64%, and 86%. Conclusion Patients with a T3 glottic LSCC had unexpectedly poor survival, especially when compared with patients with a T4 tumor. Patients with T4 disease were primarily treated with laryngectomy and postoperative radiotherapy (RT)/chemoradiotherapy (CRT), while most patients with T3 LSCC were treated with RT/CRT.
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Affiliation(s)
- Rasmus Blomkvist
- Division of ENT Diseases, Department of Clinical Science Intervention and Technology, Karolinska Institutet Stockholm Sweden
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
| | - Linda Marklund
- Division of ENT Diseases, Department of Clinical Science Intervention and Technology, Karolinska Institutet Stockholm Sweden
- Medical Unit, Head Neck, Lung and Skin Cancer Karolinska University Hospital Stockholm Sweden
| | - Lalle Hammarstedt‐Nordenvall
- Division of ENT Diseases, Department of Clinical Science Intervention and Technology, Karolinska Institutet Stockholm Sweden
- Medical Unit, Head Neck, Lung and Skin Cancer Karolinska University Hospital Stockholm Sweden
| | - Eivind Gottlieb‐Vedi
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - Antti Mäkitie
- Division of ENT Diseases, Department of Clinical Science Intervention and Technology, Karolinska Institutet Stockholm Sweden
- Department of Otorhinolaryngology – Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Björn Palmgren
- Division of ENT Diseases, Department of Clinical Science Intervention and Technology, Karolinska Institutet Stockholm Sweden
- Medical Unit, Head Neck, Lung and Skin Cancer Karolinska University Hospital Stockholm Sweden
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11
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Treating Head and Neck Cancer in the Age of Immunotherapy: A 2023 Update. Drugs 2023; 83:217-248. [PMID: 36645621 DOI: 10.1007/s40265-023-01835-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
Most patients diagnosed with head and neck squamous cell carcinoma (HNSCC) will present with locally advanced disease, requiring multimodality therapy. While this approach has a curative intent, a significant subset of these patients will develop locoregional failure and/or distant metastases. The prognosis of these patients is poor, and therapeutic options other than palliative chemotherapy are urgently needed. Epidermal growth factor receptor (EGFR) overexpression is an important factor in the pathogenesis of HNSCC, and a decade ago, the EGFR targeting monoclonal antibody cetuximab was approved for the treatment of late-stage HNSCC in different settings. In 2016, the anti-programmed death-1 (PD-1) immune checkpoint inhibitors nivolumab and pembrolizumab were both approved for the treatment of patients with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy, and in 2019, pembrolizumab was approved for first-line treatment (either as monotherapy in PD-L1 expressing tumors, or in combination with chemotherapy). Currently, trials are ongoing to include immune checkpoint inhibition in the (neo)adjuvant treatment of HNSCC as well as in novel combinations with other drugs in the recurrent/metastatic setting to improve response rates and survival and help overcome resistance mechanisms to immune checkpoint blockade. This article provides a comprehensive review of the management of head and neck cancers in the current era of immunotherapy.
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Suppah M, Kamal A, Karle WE, Saadoun R, Lott DG. Outcomes of KTP Laser Ablation in Glottic Neoplasms: A Systematic Review and Meta-Analysis. Laryngoscope 2023. [PMID: 36606671 DOI: 10.1002/lary.30547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the safety and clinical effectiveness of transoral laser microsurgery (TLM) with potassium-titanyl-phosphate (KTP) laser ablation for glottic neoplasms. DATA SOURCE MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Library. REVIEW METHODS A systematic review and meta-analysis of studies assessing the safety and efficacy of KTP laser therapy in patients with early-stage glottic neoplasms. RESULTS Eight studies were included. After an average follow-up of 3.3 years, the overall survival and disease-free survival for patients who underwent KTP were 90.7% (95% CI 85%-96.5%) and 98.5% (95% CI 97.3%-99.8%), respectively. In the single-arm meta-analysis, the pooled estimate of recurrence was 7.7% (95% CI 3.4%-12%). The overall voice handicap index (VHI) estimate attributed to KTP in the single-arm meta-analysis was 6.76 (95% CI [3.05, 10.48]) and 5.21 (95% CI [2.86, 7.56]) within 6 months and after a one-year follow-up, respectively. CONCLUSION KTP laser ablation is a safe and effective method for treating patients with early glottic neoplasms. Laryngoscope, 2023.
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Affiliation(s)
- Mustafa Suppah
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Abdallah Kamal
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William E Karle
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Rakan Saadoun
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David G Lott
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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13
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Ming W, Zuo J, Han J, Chen J. Establishment of prognostic nomogram for T1N0M0 glottic squamous cell carcinoma: an SEER database analysis. Eur Arch Otorhinolaryngol 2022; 280:2397-2410. [PMID: 36454384 DOI: 10.1007/s00405-022-07763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The study aimed to construct prognostic models for OS and CSS in patients with T1N0M0 glottic SCC. In addition, we used PSM to re-assess the effect of surgery alone and radiation alone. METHODS The Surveillance, Epidemiology, and End Results database was searched for patients with confirmed T1N0M0 glottic SCC. Patients with complete data were randomly divided into the training and the validation cohort (7:3), Cox-regression analysis was performed to identified significant predictors of OS and CSS. PSM was used to mimic randomized controlled the trials. Kaplan-Meier survival method and log-rank tests were utilized for survival analysis. RESULTS A total 1827 patients met the inclusion criteria. Survival analysis indicated that the patients who underwent the primary site surgery had a better OS (P = 0.002) and CSS (P = 0.008), compared with non-surgery patients. Cox-regression analysis proved that age, marital status, T1 stages, surgery, radiation, sequential treatments, and chemotherapy had significant effects on OS. While age, marital status, histologic grade, surgery, radiation, sequential treatments, and chemotherapy were substantially associated with CSS. Patients who received primary site surgery had a better OS and CSS, compared with non-surgical patients. Patients receiving radiation had a better CSS than non-radiation patients. However, patients who received sequential treatments or chemotherapy had a worse OS and CSS, compared with controlled groups. Predictive nomogram models were established to predict patients' prognosis with good consistency between the actual observation and the nomogram prediction. Before PSM, patients who underwent surgery alone had a better OS and CSS than those who received radiation alone. After PSM, patients receiving surgery still had a better OS than those receiving radiation. However, there were no statistically significant differences in CSS. CONCLUSIONS Nomogram models were developed to predict OS and CSS in patients with T1N0M0 glottic SCC. Primary site surgery could definitely increase OS and CSS, while radiation could significantly increase CSS. Using PSM, surgery alone could significantly enhance OS, as compared to radiation alone. Chemotherapy should not be recommended for early glottic carcinoma.
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Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
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14
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Kim MS, Wu HG, Sung MW, Kwon TK. Long-term impact of smoking cessation on new glottic cancer events in patients with early glottic cancer. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:525-530. [PMID: 36654518 PMCID: PMC9853108 DOI: 10.14639/0392-100x-n1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/13/2022] [Indexed: 01/18/2023]
Abstract
Objective Patients with early glottic cancer sometimes exhibit new glottic cancer events after 5 years. This study aimed to analyse the patterns and risk factors of new glottic cancer events in patients with early glottic cancer 5 years after initial treatment. Methods In total, 209 patients were included in this study. Age, sex, T stage, anterior commissure involvement, smoking pattern and treatment modality were retrospectively analysed. Results The median follow-up was 91 (range, 60-266) months. The median time for the occurrence of new glottic cancer events was 97 (range, 61-199) months. New glottic cancer events occurred 5 years after initial treatment in 16 (7.6%) patients, among whom 12 (75.0%) had new glottic cancer event lesions overlapping with initial lesions. Smoking cessation after treatment was significantly correlated with fewer new glottic cancer events after 5 years. Conclusions New glottic cancer events occurring 5 years after initial treatment in patients with early glottic cancer are not negligible. In particular, if smoking is continued after treatment, these patients can experience new glottic cancer events even after 5 years.
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Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea,Correspondence Tack-Kyun Kwon Department of Otorhinolaryngology-Head-and-Neck Surgery, Seoul National University College of Medicine, Boramae Medical Center, Room No 11221, 11th floor, Hangbok Building, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea E-mail:
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15
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Sjogren E, Hendriksma M, Piazza C, Hartl DM, Suarez C, Cohen O, de Bree R, Quer M, Poorten VV, Rodrigo JP, Civantos F, Genden E, Kowalski LP, Makitie A, Shaha A, Takes RP, Sanabria A, Guntinas-Lichius O, Rinaldo A, Ferlito A. Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review. J Voice 2022:S0892-1997(22)00069-8. [PMID: 35422356 DOI: 10.1016/j.jvoice.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
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Affiliation(s)
- Elisabeth Sjogren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cesare Piazza
- Department of Otorhinolaryngology- Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dana M Hartl
- Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Miquel Quer
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Oviedo, Spain
| | - Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Eric Genden
- Ear, Nose, Throat / Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolarynglology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School
| | - Antti Makitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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16
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Liu CH, Chien PJ, Hung LT, Wang LM, Kao YC, Tsai YJ, Chu PY. Long-term Oncologic Results and Voice Outcomes in Patients With Glottic Cancer After Modified Type III Cordectomy. Otolaryngol Head Neck Surg 2022; 167:839-845. [PMID: 35167384 DOI: 10.1177/01945998221075317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Transoral laser microsurgery and radiotherapy provide high and comparable cure rates for the treatment of early glottic cancer. However, the voice outcomes after treatment remain controversial. A modified type III cordectomy technique was proposed in 2006, and preliminary results showed it to be an oncologically safe method with satisfactory voice outcomes. This study aimed to evaluate oncologic and voice outcomes after long-term follow-up of these patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. METHODS Between 2006 and 2018, 42 patients with glottic cancer underwent a modified type III cordectomy. This technique resected the tumor and upper part of the vocal folds and preserved the lower part of the vocalis muscle as a scaffold to improve glottis closure. The oncologic results and voice outcomes were evaluated at a median follow-up of 68 months. RESULTS The primary tumor stages included 13 T1 (31%), 26 T2 (64%), and 3 T3 (7%). Eight patients (19%) had local recurrence, and 6 underwent successful salvage with transoral laser microsurgery with or without postoperative radiotherapy with laryngeal preservation. The 5-year rate of local control was 80%; laryngeal preservation, 95%; overall survival, 89%; and disease-specific survival, 97%. The final laryngeal preservation rate was 95% (40/42). The voice outcomes were satisfactory and comparable to those of patients who underwent type I and II cordectomies. CONCLUSION The modified type III cordectomy has been proven to be an oncologically safe method with satisfactory voice outcomes after long-term follow-up in selected cases of early glottic cancer.
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Affiliation(s)
- Chin-Hsuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Li-Mei Wang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Ya-Chuan Kao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Yueh-Ju Tsai
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei
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17
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Functional outcomes of early laryngeal cancer - endoscopic laser surgery versus external beam radiotherapy: a systematic review. The Journal of Laryngology & Otology 2021; 136:898-908. [PMID: 34641985 DOI: 10.1017/s0022215121002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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de Carvalho GB, Kohler HF, de Mello JBH, Lira RB, Pellizzon ACDA, Vartanian JG, Kowalski LP. Organ preservation and oncological outcomes in early laryngeal cancer: a propensity score-based study. ACTA ACUST UNITED AC 2021; 41:317-326. [PMID: 34533535 PMCID: PMC8448187 DOI: 10.14639/0392-100x-n0870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Background The rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy. Methods This retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group. Results Regarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss. Conclusions Patients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Julia Bette Homem de Mello
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil.,Carcinogenesis Molecular Program, National Institute of Cancer - INCA, Rio de Janeiro, RJ, Brazil
| | - Renan Bezerra Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil.,Head and Neck Surgery Department and LIM 28, University of Sao Paulo Medical School, Sao Paulo, Brazil
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19
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Mucha-Małecka A, Małecki K, Amrogowicz N, Biesaga B, Modrzejewski M. Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy. Sci Rep 2021; 11:17717. [PMID: 34489495 PMCID: PMC8421427 DOI: 10.1038/s41598-021-96146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.
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Affiliation(s)
- Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - Krzysztof Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
- Faculty of Health Sciences, Jagiellonian University in Cracow, Michałowskiego 12, 31-126, Cracow, Poland
| | - Natalia Amrogowicz
- 1St Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - Maciej Modrzejewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
- Department of Otolaryngology, Head and Neck Surgery, 5th Military Hospital with Polyclinic, Wroclawska 1-3, 30-901, Cracow, Poland
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20
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Sheth S, Farquhar DR, Schrank TP, Stepp W, Mazul A, Hayward M, Lenze N, Little P, Jo H, Major MB, Chera BS, Zevallos JP, Hayes DN. Correlation of alterations in the KEAP1/CUL3/NFE2L2 pathway with radiation failure in larynx squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2021; 6:699-707. [PMID: 34401494 PMCID: PMC8356873 DOI: 10.1002/lio2.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/27/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Patients with laryngeal squamous cell carcinoma (LSCC) often fail radiation therapy (RT), when received as monotherapy or in combination with other treatment modalities. Mechanisms for RT failure are poorly understood. We hypothesized that tumors failing RT would have increased rates of somatic mutations in genes associated with radiation resistance, particularly in genes associated with the NFE2L2 oxidative stress pathway. Using targeted exome sequencing on pretreated LSCC tumors, we retrospectively compared somatic mutation profile with clinical data and response to treatment. METHODS Tumors were classified as either radiation-resistant (RR) or radiation-sensitive (RS). RR was defined as persistent or recurrent disease within 2 years of receiving full-dose RT. Early stage (ES) LSCC was defined as Stage I or II tumors without lymph node involvement. Eight genes associated with radiation resistance were prioritized for analysis. RT-qPCR was performed on five NFE2L2 pathway genes. RESULTS Twenty LSCC tumors were included and classified as either RR (n = 8) or RS (n = 12). No differences in individual rates of somatic mutations by genes associated with radiation resistance were identified. Higher rates of total mutational burden (TMB) and increased alterations associated with the NFE2L2 pathway was observed in RR vs RS tumors (P < .05). In an analysis of only ES-LSCC patients (RR, n = 3 and RS, n = 3), RR tumors had increased NFE2L2 somatic pathway mutations (P = .014) and increased NQO1 mRNA expression (P = .05). CONCLUSION Increased TMB and NFE2L2 pathway alterations were associated with radiation resistance in LSCC. NQO1 mRNA expression may serve as a biomarker for RT response in ES-LSCC.Level of Evidence: II1.
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Affiliation(s)
- Siddharth Sheth
- Division of Hematology and Oncology, Department of MedicineThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Douglas R. Farquhar
- Department of Otolaryngology‐Head and Neck SurgeryThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Travis P. Schrank
- Department of Otolaryngology‐Head and Neck SurgeryThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Cell Biology and PhysiologyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Wesley Stepp
- Department of Otolaryngology‐Head and Neck SurgeryThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Angela Mazul
- Department of OtolaryngologyWashington University in Saint Louis, School of MedicineSt. LouisMissouriUSA
| | - Michele Hayward
- Division of Hematology and Oncology, Department of MedicineThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Nicholas Lenze
- Department of Otolaryngology‐Head and Neck SurgeryThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Paul Little
- Division of Hematology and Oncology, Department of MedicineThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Heejoon Jo
- Division of Hematology‐Oncology, Department of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - M. Ben Major
- Department of Cell Biology and PhysiologyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Bhishamjit S. Chera
- Department of Radiation OncologyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jose P. Zevallos
- Department of OtolaryngologyWashington University in Saint Louis, School of MedicineSt. LouisMissouriUSA
| | - D. Neil Hayes
- Division of Hematology‐Oncology, Department of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
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21
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Bridhikitti J, Chotigavanich C, Apiwarodom N. Voice Outcomes after Radiotherapy for Laryngeal Cancer. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1729497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objective The study was aimed to assess changes in voice outcomes after radiotherapy in laryngeal cancer patients.
Materials and Methods The study included 60 laryngeal cancer patients treated with definitive radiotherapy or chemoradiotherapy between 2005 and 2012. The primary endpoint of this study was to assess abnormalities of the patients’ voices after the treatment. The Thai version of the Voice Handicap Index (VHI) and xerostomia questionnaire were conducted by telephone. Videostroboscopic examination was done to objectively assess voice outcomes.
Results The median age of patients was 63 years. Most patients had glottic cancer (84.1%) and T1–2 disease (84.1%). The median time from treatment to the study was 46 months. In terms of the total VHI score, most patients were in the normal and slight handicap groups (22% and 71.4%, respectively). Only 4.8% and 1.6% of the patients were in moderate and severe handicap group, respectively. Twenty-eight patients had significant xerostomia. Videostroboscopy examination was done in 23 patients and most common findings were telangiectasia (95.7%), abnormal mucosal wave (47.8%), and abnormal glottic closure configuration (34.8%). Regarding total VHI score, lower radiation dose, conventional radiation dose per fraction, longer period after treatment, and significant xerostomia status were significantly correlated with worse voice outcomes. There were no statistically significant correlations between the videostroboscopic findings and VHI scores.
Conclusion Voice outcomes in most of laryngeal cancer patients treated with radiotherapy had a normal or mild handicap at more than 1 year of follow-up. Only 4.8% and 1.6% of the patients had moderate and severe voice outcome handicap, respectively.
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Affiliation(s)
- Jidapa Bridhikitti
- Department of Radiation Oncology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanticha Chotigavanich
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nantakan Apiwarodom
- Department of Radiation Oncology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bahig H, Rosenthal DI, Nguyen-Tan FP, Fuller DC, Yuan Y, Hutcheson KA, Christopoulos A, Nichols AC, Fung K, Ballivy O, Filion E, Ng SP, Lambert L, Dorth J, Hu KS, Palma D. Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial. BMC Cancer 2021; 21:446. [PMID: 33888069 PMCID: PMC8061218 DOI: 10.1186/s12885-021-08195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
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Affiliation(s)
- Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David I. Rosenthal
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Félix-Phuc Nguyen-Tan
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David C. Fuller
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Ying Yuan
- grid.240145.60000 0001 2291 4776Biostatistics Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A. Hutcheson
- grid.240145.60000 0001 2291 4776Head and Neck Surgery Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Apostolos Christopoulos
- grid.410559.c0000 0001 0743 2111Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Anthony C. Nichols
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Kevin Fung
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Olivier Ballivy
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Edith Filion
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Sweet Ping Ng
- grid.1055.10000000403978434Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise Lambert
- Radiation Oncology Department, Centre Intégré de Cancérologie de Laval, Laval, Canada
| | - Jennifer Dorth
- grid.67105.350000 0001 2164 3847Radiation Oncology Department, Case Western Reserve University, Cleveland, USA
| | - Kenneth S. Hu
- Radiation Oncology Department, NYU Langone Health, Newyork, USA
| | - David Palma
- grid.39381.300000 0004 1936 8884Radiation Oncology Department, Western University, London, Ontario Canada
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Li X, Li J, Cui X, Hu X, Yu P, Sun G. The Thermal Damage of Canine Vocal Fold by CO 2 Laser Under Different Laser Emission Mode. EAR, NOSE & THROAT JOURNAL 2021; 101:17S-23S. [PMID: 33719628 DOI: 10.1177/0145561321999262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to review the differences between continuous wave (CW) and UltraPulse (UP) on thermal damage of the laser with different power. METHODS Four adult beagle dogs underwent transoral laser microsurgery (TLM) using CO2 laser. The laser emission mode and power was CW (3 W, 5 W, and 8 W) and UP (3 W and 5 W), respectively. The tissue from 4 animals was evaluated histologically on postoperative days 1 and 3. The thermal damage of the laser was measured using slide scan system via SlideViewer version 1.5.5.2 software. RESULTS All dogs underwent TLM uneventfully. Under microscope examined, the laser damage area was composed of 2 parts: the vaporized zone (VPZ) and thermal damage area. The thermal damage area can be divided into thermal coagulative necrosis area (TCN) and hydropic degeneration area. The width of VPZ and TCN in UP mode was less than that in CW mode (P < .01). The data indicate that lower laser power created less thermal damage (P < .01). In addition, the width of VPZ on postoperative day 3 was less than that on postoperative day 1 (P < .01). CONCLUSION CO2 laser with UP and lower power could decrease the laser thermal damage and may offer more prompt wound healing.
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Affiliation(s)
- Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jiaying Li
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Locatello LG, Bruno C, Gallo O. Early glottic cancer recurrence: A critical review on its current management. Crit Rev Oncol Hematol 2021; 160:103298. [PMID: 33716199 DOI: 10.1016/j.critrevonc.2021.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Recurrent early glottic cancer (rEGC) poses several issues in terms of timely diagnosis, correct re-staging, and treatment. We want to critically review the latest evidence about rEGC considering its epidemiology, biology, diagnostic challenges, and treatment strategies. METHODS A systematic search of the literature using PubMed from 1990 to October 31, 2020 was performed. RESULTS There are many different treatment options available (open surgery, transoral mini-invasive surgery, radiotherapy), and many factors related to the patient's status and previous treatments must be considered when planning the best management strategy for rEGC. While its overall prognosis remains satisfactory, it is of the utmost importance to appreciate all the clinical implications derived from the choice of the initial therapeutic modality, and from a correct primary and recurrent staging. CONCLUSION The balance between oncological and voice and swallowing functions represents the fundamental principle underlying rEGC management. Future studies should focus on molecular profiling of rEGC, and on the results of the emerging radiation delivery techniques and mini-invasive procedures.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Luo MS, Huang GJ, Liu HB. Prognostic factors of patients with initially diagnosed T1a glottic cancer: Novel nomograms and a propensity-score matched cohort analysis. Medicine (Baltimore) 2020; 99:e23004. [PMID: 33157944 PMCID: PMC7647548 DOI: 10.1097/md.0000000000023004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
The option of T1a glottic cancer treatments remarkably varied in different countries. This study aimed to construct predictive models to predict overall survival (OS) and cancer-specific survival (CSS) of patients with initially diagnosed T1a glottic cancer. And we used propensity score matching (PSM) to reassess the effect of treatments.Data of patients with initially diagnosed T1a glottic cancer were extracted from the Surveillance, Epidemiology, and End Results database. Patients with complete information were randomly divided into the training and the validation cohorts (7:3). Cox regression was conducted to screen significant predictors of the OS and the CSS. PSM was performed to mimic randomized controlled trials. Survival analyses were performed by Kaplan-Meier survival methods, and log-rank tests were utilized.A total of 2342 patients met the inclusion criteria. Survival analyses showed that patients who underwent primary site surgery would have better OS and CSS. Univariate analyses and multivariate analyses proved that stage, N stage, primary site surgery, and chemotherapy significantly affected both the OS and the CSS. Predictive nomograms were established to predict patients' prognosis. Finally, the OS and the CSS for patients who underwent primary site surgery alone were significantly longer than those who underwent radiation alone before and after PSM.We constructed nomograms predicting the OS and the CSS of patients with initially diagnosed T1a glottic cancer. Compared to our previous studies, this study indicated that primary site surgery may be superior to radiation and chemotherapy. At present, chemotherapy should be not recommended for T1a glottic cancer patients.
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Affiliation(s)
- Meng-Si Luo
- Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong
| | - Guan-Jiang Huang
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Hong-Bing Liu
- Department of Otolaryngology-head and neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Effects of Antiacid Therapy on Granuloma after Transoral Type IV-VI Cordectomy in Patients with Early-Stage Glottic Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4178376. [PMID: 32851070 PMCID: PMC7436350 DOI: 10.1155/2020/4178376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022]
Abstract
Objective To investigate whether preventive administration of a proton pump inhibitor (PPI) can reduce the occurrence and development of traumatic granuloma (TG) following type IV-VI cordectomy. Methods We retrospectively analyzed the status of postoperative granulomas in 37 patients who underwent type IV-VI cordectomy due to glottic cancer and determined whether postoperative administration of a PPI had any impact on granuloma formation and development. Results The percentage and number of patients with granuloma in the PPI treatment group (experimental group) at the 1st, 2nd, 3rd, and 6th month following surgery were 81.25% (13/16), 25.00% (4/16), 18.75% (3/16), and 0.00% (0/16), respectively. The percentage and number of patients with granuloma in the no-PPI group (control group) were 95.24% (20/21), 71.43% (15/21), 52.38% (11/21), and 14.29% (3/21), respectively. The granuloma percentage of the PPI treatment group was lower than that of the control group at all postoperative time points assessed. The differences were not statistically significant at the 1st month (p = 0.175) but were statistically significant at the 2nd and 3rd months after surgery (p = 0.005, p = 0.037). Conclusion Preventive use of a PPI in patients after type IV-VI cordectomy can shorten the TG recovery duration and may reduce the severity of TG, but it cannot prevent TG from occurring. Our results should be confirmed by prospective randomized controlled trials with large sample sizes.
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Carvalho GBD, Kohler HF, Lira RB, Vartanian JG, Kowalski LP. Survival results of 3786 patients with stage I or II laryngeal squamous cell carcinoma: a study based on a propensity score. Braz J Otorhinolaryngol 2020; 88:337-344. [PMID: 32771434 PMCID: PMC9422720 DOI: 10.1016/j.bjorl.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Laryngeal squamous cell carcinoma is the second most prevalent malignancy among head and neck tumors, and the treatment of patients with stage I or II disease can be performed with surgery or radiation therapy. National population studies describing therapeutic results comparing these modalities are unusual, but they can be very important to direct treatment guidelines. Objective To evaluate the survival results of patients with laryngeal squamous cell carcinoma at clinical stages I or II, according to the main therapeutic modalities used. Methods Cross-sectional, population-based study using the database of Fundação Oncocentro de São Paulo from January 2000 to March 2019. Inclusion criteria were patients with laryngeal squamous cell carcinoma in clinical stages cT1-2N0. To compensate for the non-random allocation of patients and the imbalance between confounding variables between groups, we used the propensity score methodology. Results A total of 3786 patients met the inclusion criteria. Regarding the cT stage, there were 2171 patients (57.3%) with cT1 tumors. Patients in the public health system had a longer time between diagnosis and treatment (p < 0.001). The analysis by propensity score showed that patients treated with surgery had a tendency towards better disease-specific survival (p = 0.012). Comparing radiotherapy alone versus its combination with radiochemotherapy, radiotherapy alone showed a tendency towards a better survival rate (p < 0.001). Conclusion Analysis by propensity score identified better results for disease-specific survival in patients with laryngeal squamous cell carcinoma at clinical stages I and II treated by surgery when compared to radiotherapy.
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Affiliation(s)
- Genival Barbosa de Carvalho
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Hugo Fontan Kohler
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Renan Bezerra Lira
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - José Guilherme Vartanian
- A C Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- A.C. Camargo Cancer, Centro de Referência de Tratamento dos Pacientes com Tumores de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia de Cabeça e Pescoço e LIM 28, São Paulo, SP, Brazil
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28
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Silverman DA, Zhan KY, Puram SV, Eskander A, Teknos TN, Rocco JW, Old MO, Kang SY. Predictors of Postoperative Radiation Following Laser Resection in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2020; 163:1218-1225. [PMID: 32631147 DOI: 10.1177/0194599820933183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). STUDY DESIGN Retrospective observational study of the National Cancer Database. SETTING National Cancer Database review from 2004 to 2014. PATIENTS AND METHODS A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. RESULTS The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. CONCLUSIONS Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.
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Affiliation(s)
- Dustin A Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Kevin Y Zhan
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Sidharth V Puram
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Siteman Cancer Center, Saint Louis, Missouri, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Theodoros N Teknos
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
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Parker NP, Weidenbecher MS, Friedman AD, Walker BA, Lott DG. KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study. Ann Otol Rhinol Laryngol 2020; 130:47-55. [PMID: 32627613 DOI: 10.1177/0003489420938100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The primary objectives were to report oncologic outcomes of transoral laser microsurgery with potassium-titanyl-phosphate (KTP) laser (TLM-KTP) ablation of early glottic cancer (EGC). The secondary objectives were to report vocal outcomes and to analyze factors that might influence outcomes. METHODS A multi-institutional, retrospective analysis of consecutive patients treated for T1 or T2 glottic squamous cell carcinoma undergoing TLM-KTP ablation with at least 2 years of follow-up was performed. Patients with prior radiation or surgery for laryngeal disease were excluded. PRIMARY OUTCOME MEASURES INCLUDED surgical failures requiring radiation or laryngectomy, disease-specific survival (DSS), and overall survival (OS). Secondary outcome measures included: pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. The effects of smoking status, stage, and anterior commissure involvement on outcomes were analyzed. RESULTS Overall 88 patients met inclusion criteria (83% male, 79.5% current or former smokers). Mean age was 68 (standard deviation (SD): 12). Mean follow-up was 39.5 months (SD: 15.3). Staging included 50 T1a, 21 T1b, and 20 T2 tumors, including three metachronous second primaries. Radiation and/or laryngectomy avoidance was achieved in 87/88 (98.9%) of patients, inclusive of 24 patients requiring KTP re-treatments. Two patients had biopsy-proven recurrence (2.3%), but only 21 of 24 re-treated patients received a formal biopsy. No patients died from laryngeal cancer. DSS and OS were 100% and 92.3%, respectively. The mean VHI-10 scores were 19.3 preoperatively, 3.8 at 6-months postop, and 3.8 at 2-years postop. Smokers had a longer interval to re-treatment (P = .03), patients with T2 lesions had a shorter interval to re-treatment (0.02), and patients with T2 lesions presented with worse initial VHI-10 scores (0.002). CONCLUSIONS A multi-institutional, retrospective case series of TLM-KTP ablation of EGC demonstrated excellent oncologic outcomes when close surveillance and proactive re-treatments were utilized. Disease-specific survival, overall survival, and vocal function were excellent. Additional studies are necessary to further analyze the merits and risks of this treatment approach.
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Affiliation(s)
- Noah P Parker
- Departments of Otolaryngology-Head and Neck Surgery and Speech and Hearing Sciences, Indiana University, Indianapolis, IN, USA
| | - Mark S Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve, Cleveland, OH, USA
| | - Aaron D Friedman
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Brian A Walker
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Jung EK, Jin SM, Kim JG, Jung JU, Lee DH, Lee JK, Lim SC, Chung WK, Kim HK, Hwang JE, Shim HJ, Bae WK, Cho SH, Chung IJ, Yoon TM. Comparison of long-term treatment outcomes of T2N0M0 laryngeal squamous cell carcinoma using different treatment methods. Oncol Lett 2020; 20:921-930. [PMID: 32566021 DOI: 10.3892/ol.2020.11628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/01/2020] [Indexed: 11/06/2022] Open
Abstract
Early [stage I and II (T2N0M0)] laryngeal cancer types are currently recommended to be treated with a single modality, consisting of definitive radiation therapy or larynx-preserving surgery. Although the treatment outcomes of stage I are good, the frequency of successful outcomes decreases with T2N0M0. Therefore, the present study investigated the treatment outcomes of different treatment methods in T2N0M0 laryngeal cancer. In total, 83 patients with previously untreated T2N0M0 laryngeal squamous cell carcinoma were enrolled. Patients were grouped by treatment method: Radiation therapy (RT; 27 patients); chemoradiotherapy (CRT; 46 patients) with cisplatin base; and surgery-based therapy (SBT; ten patients). The recurrence rates of the RT, CRT and SBT groups were 44.4, 19.6 and 50%, respectively. Moreover, the local control rates of the RT, CRT and SBT groups were 55.6, 87.0 and 80%, respectively. The CRT group had a significantly lower recurrence rate and higher local control rate compared with the RT group (P<0.05). In the survival analysis, overall and disease-specific survival rate did not differ significantly among the treatment groups. However, 3- and 5-year disease-free survival rates (DFS) of the RT group were both 55%, those of the SBT group were both 50% and those of the CRT group were both 80%. Furthermore, the DFS was significantly higher in CRT group compared with the other groups (P=0.02). Using multivariate analysis with Cox regression, it was found that the treatment method was the most important factor for DFS and had a significant impact in the CRT group. In addition, in patients with glottic cancer with anterior commissure and subglottic invasion, the CRT group had significantly improved DFS compared with the RT group, whereas there was no significant difference between the two groups in patients without subglottic invasion. According to National Cancer Institution Common Toxicity Criteria (version 5.0), more patients had toxicity in the CRT group compared with the RT group. However, in the RT and CRT groups, no patients demonstrated mortality due to toxicity, and treatment-related toxicities were manageable. Collectively, although definitive conclusions could not be established, due to the limitations of this retrospective study, the results suggest that CRT had a positive impact on the local control and DFS rates with manageable toxicity in patients with T2N0M0 laryngeal cancer.
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Affiliation(s)
- Eun Kyung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Seong-Min Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Jae-Gu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Jae-Uk Jung
- Department of Radiation Oncology, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Dong Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Sang Chul Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Jun-Eul Hwang
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Woo-Kyun Bae
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 519-763, Republic of Korea
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T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis? Cancers (Basel) 2020; 12:cancers12061485. [PMID: 32517265 PMCID: PMC7352716 DOI: 10.3390/cancers12061485] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.
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Jayakrishnan TT, White RJ, Greenberg L, Colonias A, Wegner RE. Predictors of chemotherapy and its effects in early stage squamous cell carcinoma of the larynx. Laryngoscope Investig Otolaryngol 2020; 5:445-452. [PMID: 32596486 PMCID: PMC7314463 DOI: 10.1002/lio2.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of larynx is a common head and neck cancer. For cases that are node negative, the role of definitive concurrent chemoradiation is unclear and not supported by guidelines but used at provider discretion. To address this knowledge gap, we examined the oncological outcomes with additional chemotherapy and factors correlated with the chemotherapy administration. METHODS We queried the National Cancer Database for patients with early stage (T2N0M0) laryngeal SCC treated nonsurgically. Multivariable logistic regression identified predictors of chemotherapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases. RESULTS We identified 7181 patients meeting the eligibility criteria, of which 1568 (22%) patients received chemotherapy in addition to radiation. Predictors of chemotherapy use included younger age, Caucasian race, more remote year of treatment, higher grade, sites other than glottis, treatment at a community cancer center, and use of intensity-modulated radiation therapy. Median overall survival was not significantly different in the two arms analyzed-65 months (95% confidence interval [CI] 60, 72months) with chemotherapy compared to 70 months without chemotherapy (95% CI 66, 75 months, P<.37). Predictors for survival on propensity-matched multivariable analysis were increased age, male sex, less education, lower income, higher comorbidity score, receipt of treatment at a community center, and nonglottic sites. CONCLUSIONS This study shows no clear survival benefit with chemotherapy in early stage disease. Although this implies that chemotherapy should not be routinely delivered, individualized judgment and prospective studies are recommended as the biology behind this interesting finding is undefined. LEVEL OF EVIDENCE 2C (Outcomes Research).
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Affiliation(s)
| | - Richard J. White
- Department of Internal MedicineAllegheny Health NetworkPittsburghPA
| | - Larisa Greenberg
- Division of Medical OncologyAllegheny Health Network Cancer InstitutePittsburghPA
| | - Athanasios Colonias
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
| | - Rodney E. Wegner
- Division of Radiation OncologyAllegheny Health Network Cancer Institute, Allegheny General HospitalPittsburghPA
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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Singhal M, Prabhash K, Babu G, Chaturvedi P, Kuriakose M, Birur P, Anand AK, Kaushal A, Mahajan A, Syiemlieh J, Gairola M, Ramachandra P, Goyal S, John S, Nayyar R, Patil VM, Rao V, Roshan V, Rath GK. Indian clinical practice consensus guidelines for the management of laryngeal cancer. Indian J Cancer 2020; 57:S19-S21. [PMID: 32167068 DOI: 10.4103/0019-509x.278973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Manish Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Moni Kuriakose
- Department of Surgical Oncology, Cochin Cancer Research Centre, Cochin, Kerala, India
| | - Praveen Birur
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences (KLESIDS), Bangalore, Karnataka, India
| | - Anil K Anand
- Department of Radiation Oncology, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Ashish Kaushal
- Department of Medical Oncology, HCG Cancer Centre, Ahmedabad, Gujarat, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Judita Syiemlieh
- Department of Radiation Oncology, Civil Hospital, Shillong, Meghalaya, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Prakash Ramachandra
- Department of Radiation Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Subashini John
- Department of Radiotherapy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rohit Nayyar
- Department of Surgical Oncology, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vishal Rao
- Department of Surgical Oncology, HCG Cancer Centre, Bangalore, Karnataka, India
| | - Vikas Roshan
- Department of Radiation Oncology, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu, Jammu and Kashmir, India
| | - G K Rath
- Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Delhi, India
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Chung SY, Lee CG. Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer. Head Neck 2019; 42:854-859. [PMID: 31854475 DOI: 10.1002/hed.26052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Generally, radiotherapy for patients with early glottic cancer includes treatment of the whole larynx. This study was conducted to evaluate the treatment outcomes and toxicity in patients who received single vocal cord irradiation (SVCI) for T1a classification glottic cancer. METHODS A total of 34 patients diagnosed with clinical T1aN0M0 classification squamous cell carcinoma of the glottis who received radiotherapy to the single vocal cord were included for analysis. RESULTS Median follow-up period was 41.3 months (range, 6.4-124.5 months). The 3-year and 5-year local control (LC) rates were both 96.8%. Grade 3 radiation dermatitis was observed as severe acute toxicity in two (6%) patients. No patients experienced any severe late toxicity events during follow-up. CONCLUSIONS SVCI showed good LC, low acute and late toxicities, and reasonable voice recovery. SVCI may be considered a feasible treatment strategy for patients with T1a glottic cancer.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Tulli M, Re M, Bondi S, Ferrante L, Dajko M, Giordano L, Gioacchini FM, Galli A, Bussi M. The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta-analysis. Laryngoscope 2019; 130:1932-1940. [PMID: 31721216 DOI: 10.1002/lary.28395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The anterior commissure is considered a laryngeal subsite, but it is not taken into account in the current T-staging system. The impact of anterior commissure involvement (ACI) on the oncologic outcomes of T1 glottic tumors has not been well defined and remains controversial. The aim of this study was to assess the influence of ACI in the prognosis of T1 glottic tumors. METHODS A systematic review and meta-analysis of observational studies was performed by including studies published up to July 2019. Studies were selected if they had investigated the local control rate (LCR) at 5 years of clinical stage I (T1 and N0) glottic squamous cell carcinoma with and without ACI. The difference in LCR at 5 years between T1 glottic tumors without and with ACI was evaluated. RESULTS The meta-analysis showed that the difference in LCR at 5 years between T1 glottic tumors without and with ACI is 12% (95% confidence interval: 8%-16%, p < 0,0001, I2 = 34.81%). CONCLUSIONS Our study pointed out that the anterior commissure involvement is a negative prognostic factor in LCR at 5 years for T1 glottic tumors. Our results suggest the need to consider ACI in the T staging of glottic tumors. Laryngoscope, 130:1932-1940, 2020.
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Affiliation(s)
- Michele Tulli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Bondi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marianxhela Dajko
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Federico M Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Mihashi R, Chitose SI, Sato F, Tanaka H, Sato K, Ono T, Fukahori M, Sueyoshi S, Kurita T, Sato K, Umeno H. Endoscopic Sealing With a Polyglycolic Acid Sheet for Restoration of Vocal Fold Mucosa in Dogs. Laryngoscope 2019; 130:E436-E443. [PMID: 31693183 DOI: 10.1002/lary.28357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice outcomes of cordectomy for early glottic cancer are often poor due to vocal fold scarring and tissue defects. Improvements in this aspect could make cordectomy a more acceptable treatment option than radiotherapy. We hypothesized that a polyglycolic acid (PGA) sheet could be used to cover vocal fold defects. The present study aimed to prevent vocal fold scarring after cordectomy using the PGA sheet. STUDY DESIGN Animal experiment. METHODS Nine male beagles were divided into three groups including a control group (n = 3). Following cordectomy, the vocal fold defect was covered with the PGA sheet plus fibrin glue (PGA group; n = 3) or with the PGA sheet plus fibrin glue containing basic fibroblast growth factor (bFGF; the PGA-bFGF group, n = 3). Vocal folds were chronologically observed, and larynges were removed 6 months after surgery. Mucosal amplitude was measured using a high-speed camera, and histological analysis was performed. RESULTS The re-epithelialization process was delayed in the PGA and PGA-bFGF groups compared with the control group. The mucosal amplitude was significantly more normalized and the thickness ratio significantly higher in the PGA and PGA-bFGF groups compared with the control group. The PGA-bFGF group had the highest elastic fiber density, followed by the PGA group and then the control group, with a significant difference between the PGA-bFGF and control groups. CONCLUSIONS The PGA sheet plus fibrin glue could serve as an effective regenerative scaffold for reconstructing vocal fold morphology and function after cordectomy, with the potential benefit of establishing an endoscopic sealing method for vocal fold defects. LEVEL OF EVIDENCE NA Laryngoscope, 130:E436-E443, 2020.
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Affiliation(s)
- Ryota Mihashi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Fumihiko Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hisaichiro Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminori Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shintaro Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminobu Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Jumaily M, Faraji F, Osazuwa-Peters N, Walker RJ, Ward GM. Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma. Oral Oncol 2019; 97:105-111. [DOI: 10.1016/j.oraloncology.2019.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 12/28/2022]
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Vaculik MF, MacKay CA, Taylor SM, Trites JRB, Hart RD, Rigby MH. Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO 2 transoral laser microsurgery and radiotherapy. J Otolaryngol Head Neck Surg 2019; 48:44. [PMID: 31481120 PMCID: PMC6724253 DOI: 10.1186/s40463-019-0367-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to compare the oncologic outcomes of CO2 transoral laser microsurgery (TLM) and radiotherapy (RT) for treatment of T1 glottic carcinoma. METHODS A literature search was conducted in the following databases: Medline/PubMed, Web of Science, EMBASE, and the Cochrane Library. Search results were screened, and publications comparing oncologic outcomes of T1N0M0 glottic carcinoma treated with TLM or RT were included. Data was extracted independently by two authors, and publication quality was graded according to the Oxford Centre for Evidence-based Medicine. Meta-analysis was performed for overall survival, disease specific survival, laryngeal preservation, and local control. RESULTS Sixteen studies were included in the meta-analysis, the majority being retrospective cohort studies with two prospective cohort studies. Included studies were rated as either Level II or III evidence. Meta-analysis favoured treatment with TLM for T1 glottic carcinoma patients for the following outcomes: overall survival (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.07-2.14; P = 0.02), disease specific survival (OR, 2.70; CI, 1.32-5.54; P = 0.007), and laryngeal preservation (OR, 6.31; CI, 3.77-10.56; P < 0.00001). There was no difference in local control between TLM and RT in T1 glottic cancer (OR, 1.19; CI, 0.79-1.81; P = 0.40). DISCUSSION Our study provides a current and thorough comparison of TLM and RT outcomes in T1 glottic carcinoma. Limitations of our study include lack of randomized control trials, and non-randomized allocation of patients to treatment groups. Our meta-analysis suggests that TLM is the superior modality in terms of overall survival, disease specific survival, and laryngeal preservation. Future prospective randomized controlled studies are required for confirming these findings and developing appropriate clinical practice guidelines. LEVEL OF EVIDENCE 2A; as per the Centre of Evidence Based Medicine.
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Affiliation(s)
- Michael F Vaculik
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin A MacKay
- Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada
| | - S Mark Taylor
- Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada
| | - Johnathan R B Trites
- Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada
| | - Robert D Hart
- Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada
| | - Matthew H Rigby
- Dalhousie Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3044, Dickson Bldg. 5820 University Avenue, Halifax, NS, B3H 1V9, Canada.
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Mucha-Małecka A, Chrostowska A, Urbanek K, Małecki K. Prognostic factors in patients with T1 glottic cancer treated with radiotherapy. Strahlenther Onkol 2019; 195:792-804. [PMID: 31214734 PMCID: PMC6704086 DOI: 10.1007/s00066-019-01481-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/03/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors. METHODS We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14-145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients. RESULTS The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients' age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS. CONCLUSIONS Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.
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Affiliation(s)
- A Mucha-Małecka
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - A Chrostowska
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Urbanek
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
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Sürmeli M, Oysu C, Yılmaz AAŞ, Deveci İ, Karabulut B, Sunter AV, Yiğit Ö, Bıcakçı BC. Comparison of Voice Quality and Cost Effectiveness of Endoscopic Cordectomy Using Microdissection Electrodes with Laser Cordectomy and Radiotherapy. Turk Arch Otorhinolaryngol 2019; 57:1-6. [PMID: 31049245 DOI: 10.5152/tao.2019.4044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the acoustic parameters and the cost effectiveness achieved after endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM) with those of transoral laser cordectomy and radiotherapy. Methods The study included 81 disease-free patients previously treated for early larynx carcinoma (30 with ECRM, 27 with transoral laser cordectomy, 24 with primary radiotherapy). Post-treatment voice analysis was performed in all patients. Additionally, the cost effectiveness of all treatment procedures was calculated. Results The GRBAS (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) scale showed a significant difference between the groups (p<0.001). The mean values for perceptive assessment score in the radiotherapy group were significantly lower than those in the ECRM group (p<0.05). There were no significant differences between the ECRM group and the transoral laser cordectomy group in terms of the perceptive assessment scores (p>0.05 for all). Percent jitter, percent shimmer and fundamental frequency (F0) were significantly different in the radiotherapy group than the ECRM and the transoral laser cordectomy groups (p<0.05). Maximum phonation time (MPT) in the radiotherapy group was significantly longer than the ECRM and transoral laser cordectomy groups (p<0.001). There were no significant differences between the ECRM group and the transoral laser cordectomy group in terms of the MPT (p>0.05). The mean cost of the ECRM technique was statistically lower than the other treatment techniques (p<0.05). Moreover, the length of hospital stay after ECRM was statistically significantly shorter than was after laser cordectomy (p<0.05). Conclusion Objective and perceptive voice analysis after ECRM showed comparable results with transoral laser cordectomy, but poorer results than radiotherapy. Cost effectiveness of ECRM was found to be better than the other two treatment techniques.
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Affiliation(s)
- Mehmet Sürmeli
- Department of Otorhinolaryngology, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Cağatay Oysu
- Department of Otorhinolaryngology, Marmara University School of Medicine, İstanbul, Turkey
| | - Ayşe Aslı Şahin Yılmaz
- Department of Otorhinolaryngology, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - İldem Deveci
- Department of Otorhinolaryngology, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Burak Karabulut
- Department of Otorhinolaryngology, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Volkan Sunter
- Department of Otorhinolaryngology, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Beyhan Ceylaner Bıcakçı
- Department of Radiation Oncology, Kartal Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
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Abstract
Successful management of laryngeal cancer depends on careful pretreatment evaluation of patient and disease factors to arrive at accurate staging, leading to appropriate treatment selection for patients with this highly impacting disease. Surgical modalities, including transoral laser microsurgery, open partial laryngectomy, and total laryngectomy, offer options, alone or in combination with radiation and chemotherapy. Treatment strategy for laryngeal cancer should strive for cure while maintaining the best quality of life possible for the patient. Achieving the goals of initial and salvage treatment for laryngeal cancer depends on executing a plan of care determined by the expertise of the multidisciplinary team.
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Kabarriti R, Brodin NP, Ahmed S, Vogelius I, Guha C, Kalnicki S, Tomé WA, Garg MK. Origin of Locoregional Recurrences After Definitive Intensity-modulated Radiation Therapy (IMRT) for Laryngeal Cancer Determined Based on Follow-up PET/CT Imaging. Cureus 2019; 11:e3856. [PMID: 30899607 PMCID: PMC6420324 DOI: 10.7759/cureus.3856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: The aim of our study was to report on patterns of failure using detailed information from follow-up positron emission tomography-computed tomography (PET/CT) scans for patients with laryngeal squamous cell carcinoma (SCCA) treated with definitive radiation therapy using intensity-modulated radiation therapy (IMRT). Methods: One hundred and sixty-eight patients with laryngeal SCCA treated with definitive IMRT using a simultaneous integrated boost were included. The point of recurrence origin on follow-up PET/CT was determined using two separate data-driven methods. The first method, the mathematical epicenter point of origin (POEpi), calculated the mathematical focal epicenter point for which the maximum distance to the surface of the surrounding volume was smaller than for any other point. The second method, maximum standardized uptake value point of origin (POMax), calculated the voxel with maximum standardized uptake value (SUV) uptake within the recurrence volume. The failure pattern was then determined by whether the point of recurrence origin fell within the low, intermediate, or high-risk target volumes in the original treatment planning CT. Results: Thirty-five primary/nodal recurrences in 33 patients were included in the analysis. In the POEpi method, 94% (33/35) of all recurrences originated either within the high-risk gross tumor volume (GTVHigh-risk) or within an average of 0.9 ± 1.3 mm from it. In the POMax method, 91% (32/35) of all recurrences originated either within the GTVHigh-risk or within an average of 1.8 ± 1.7 mm from it. There were no recurrences outside the low-risk planning target volume (PTVLow-risk) for the POEpi method but there was one for the POMax method, which was 19.8 mm away from the edge of the gross tumor volume receiving 70 Gy (GTV70). Increasing distance between the two different origin points was strongly correlated with the size of the recurrence volume. Conclusion: The majority of recurrences for laryngeal cancer patients treated with definitive IMRT originated from within the high-dose treatment region. This can have implications for reducing clinical target volumes while using a risk-adaptive treatment approach to both constrain dose to critical areas and further escalate the dose to the gross tumor to improve locoregional control rates.
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Affiliation(s)
- Rafi Kabarriti
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - N Patrik Brodin
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - Sadia Ahmed
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | | | - Chandan Guha
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - Shalom Kalnicki
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - Wolfgang A Tomé
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - Madhur K Garg
- Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
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Jacobi C, Freundorfer R, Reiter M. Transoral laser microsurgery in early glottic cancer involving the anterior commissure. Eur Arch Otorhinolaryngol 2019; 276:837-845. [DOI: 10.1007/s00405-018-5261-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
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In Regards to Stokes et al and Bledsoe et al. Int J Radiat Oncol Biol Phys 2018; 100:804-805. [DOI: 10.1016/j.ijrobp.2017.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022]
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Cheraghlou S, Kuo P, Mehra S, Yarbrough WG, Judson BL. Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery. Otolaryngol Head Neck Surg 2018; 158:497-504. [DOI: 10.1177/0194599817742596] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective After radiation failure for early T-stage larynx cancer, national guidelines recommend salvage surgery. Total laryngectomy and conservation laryngeal surgery with an open or endoscopic approach are both used. Beyond single-institution studies, there is a lack of evidence concerning the outcomes of these procedures. We aim to study whether treatment with conservation laryngeal surgery is associated with poorer outcomes than treatment with total laryngectomy as salvage surgery after radiation failure for T1/T2 larynx cancers. Study Design A retrospective study was conducted of adult squamous cell larynx cancer cases in the National Cancer Database diagnosed from 2004 to 2012. Setting Commission on Cancer cancer programs in the United States. Methods Demographic, facility, tumor, and survival variables were included in the analyses. Multivariate survival regressions as well as univariate Kaplan-Meier analyses were conducted. Results Slightly more than 7% of patients receiving radiotherapy for T1/T2 larynx cancers later received salvage surgery. Salvage with partial laryngectomy was not associated with diminished survival as compared with total laryngectomy. However, positive surgical margins were associated with worse outcomes (hazard ratio, 1.782; P = .001), and a larger percentage of patients receiving partial laryngectomy had positive margins than those receiving total laryngectomy. Facility characteristics were not associated with differences in salvage surgery type or outcomes. Conclusion In recognition of the inherent selection bias, patients who experienced recurrences after radiation for T1/T2 larynx cancer and underwent conservation salvage laryngeal surgery demonstrated clinical outcomes similar to those of patients undergoing salvage total laryngectomy. Increased rates of positive surgical margins were observed among patients undergoing salvage conservation surgery.
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Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Phoebe Kuo
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Wendell G. Yarbrough
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L. Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:1143-1169. [PMID: 29172863 DOI: 10.1200/jco.2017.75.7385] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Nofisat Ismaila
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Jan S Lewin
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Cherie Ann Nathan
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David J Adelstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Avraham Eisbruch
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gail Fass
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Susan G Fisher
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Scott A Laurie
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Quynh-Thu Le
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Bernard O'Malley
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - William M Mendenhall
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Snehal Patel
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David G Pfister
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Anthony F Provenzano
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Randy Weber
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory S Weinstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory T Wolf
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
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Gioacchini FM, Tulli M, Kaleci S, Bondi S, Bussi M, Re M. Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review. Eur Arch Otorhinolaryngol 2017; 274:4091-4102. [DOI: 10.1007/s00405-017-4736-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
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Yesensky J, Agrawal N, Bayan S, Blair E, Portugal L, Chan J, Goldenberg D, Gooi Z. AHNS Series - Do you know your guidelines? Principles of treatment for glottic cancer: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2017; 39:1729-1732. [PMID: 28653453 DOI: 10.1002/hed.24816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/04/2017] [Indexed: 02/06/2023] Open
Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.
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Affiliation(s)
- Jessica Yesensky
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Nishant Agrawal
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Semirra Bayan
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Elizabeth Blair
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Louis Portugal
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Jason Chan
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Zhen Gooi
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
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Shelan M, Anschuetz L, Schubert AD, Bojaxhiu B, Dal Pra A, Behrensmeier F, Aebersold DM, Giger R, Elicin O. T1-2 glottic cancer treated with radiotherapy and/or surgery. Strahlenther Onkol 2017; 193:995-1004. [PMID: 28474090 DOI: 10.1007/s00066-017-1139-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal treatment strategy for stage I-II glottic squamous cell carcinoma (SCC) is not well-defined. This study analyzed treatment results and prognostic factors. PATIENTS AND METHODS This is a single-institution retrospective analysis of 244 patients with T1-2 glottic SCC who underwent normofractionated radiotherapy (RT) and/or surgery between 1990 and 2013. The primary endpoint was relapse-free survival (RFS). RESULTS Median age was 65 years (range: 36-92 years), the majority (82%) having stage I disease. Definitive RT was used in 82% (median dose: 68 Gy, 2 Gy per fraction). Median follow-up was 59 months. The 5‑year RFS rates were 83 and 75% (p = 0.05) for stage I and 62 and 50% (p = 0.47) for stage II in the RT and surgery groups, respectively. Multivariate analyses indicate T1 vs. T2 and RT vs. surgery as independent prognostic factors for RFS, with hazard ratios of 0.38 (95% confidence interval, CI: 0.21-0.72) and 0.53 (95% CI: 0.30-0.99), respectively (p < 0.05). The 5‑year overall and cause-specific survival rates in the whole cohort were 92 and 96%, respectively, with no significant differences between treatment groups. Anterior commissure involvement was neither a prognostic nor a predictive factor. The incidence of secondary malignancies was not significantly different between patients treated with and without RT (22 vs. 9% at 10 years, respectively, p = 0.18). CONCLUSION Despite a possible selection bias, our series demonstrates improved RFS with RT over surgery in stage I glottic SCC.
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Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology - Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian D Schubert
- Department of Otorhinolaryngology - Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Frank Behrensmeier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.,Radiation-Oncology-Centre, Biel - Seeland - Berner Jura, Biel, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology - Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
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